Healthcare Provider Details

I. General information

NPI: 1821252859
Provider Name (Legal Business Name): FERTILITY TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 115
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

2155 E CONFERENCE DR
TEMPE AZ
85284-2604
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-2445
  • Fax: 480-897-1283
Mailing address:
  • Phone: 480-831-2445
  • Fax: 480-889-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License NumberAP 2375
License Number StateAZ

VIII. Authorized Official

Name: JASON B BABCOCK
Title or Position: CEO
Credential: MBA, ACRP-CP
Phone: 480-831-2445